Dexamethasone Therapy in Symptomatic Chronic Subdural Hematoma (DECSA–R): A Retrospective Evaluation of Initial Corticosteroid Therapy versus Primary Surgery

Miah, Ishita P.; Herklots, Martin Willy; Roks, Gerwin; Peul, Wilco C.; Walchenbach, R.; Dammers, Rúben; Lingsma, Hester F.; Hertog, Heleen M. den; Jellema, Korné; Gaag, Niels A. van der

doi:10.1089/neu.2019.6541

Cited by 40 publications

(32 citation statements)

References 23 publications

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“…Surgery through burr hole drainage or twist drill craniostomy (BHC, TDC) is the mainstay of treatment worldwide [9,10]. Alternative strategies include watchful observation or highdose glucocorticoids administration depending on symptom severity and local protocols [11][12][13][14]. Ultimately, the aim of all therapeutic modalities is adequate symptom relieve by effective hematoma resolution.…”

Section: Introductionmentioning

confidence: 99%

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

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Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Limitations Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study. Conclusions Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

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Section: Introductionmentioning

confidence: 99%

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

et al. 2020

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“…Several factors affect the recurrence of CSDH after surgery, including the general clinical characteristics of the patient, surgical skills, perioperative management, and imaging characteristics, which are closely related to the recurrence 5,17,21,22,28 . Owing to advancements in research, clinicians can reduce surgical complications by improving the surgical skills and strengthening perioperative management, yet cases of postoperative recurrence continue to be reported.…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of the risk of postoperative recurrence in CSDH has been proven challenging in clinical research. The risk factors of recurrence reported so far mainly include the general clinical characteristics of the patient and the surgical methods, perioperative management methods, and imaging characteristics used 5,17,21,22,28 . Among them, imaging characteristics play a very important role.…”

Section: Introductionmentioning

confidence: 99%

Development of the Chronic Subdural Hematoma Grading System to Predict Postoperative Recurrence

Han¹,

Feng²,

Xu³

et al. 2021

Preprint

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Objective Assessing the risk of postoperative recurrence of chronic subdural hematoma (CSDH) is a clinical focus. To screen the main factors associated with the perioperative hematoma recurrence. We also propose a new prognostic grading system and compare it with previous grading systems to deliver a quick and effective system.Methods We included 242 unilateral patients with CSDH as the training group for modeling. Factors predicting postoperative recurrence requiring reoperation (RrR) were determined using univariate and multivariate regression analyses. The cut-off value for the brain re-expansion rate was determined through receiver operating characteristic curve analysis. Based on these, we developed a new prognostic scoring system and conducted preliminary verification. A verification group including 119 patients with unilateral CSDH was used to verify the predictive performance of the new and other grading systems.Results The key factors for predicting unilateral CSDH recurrence were cerebral re-expansion rate (≤ 40%) at postoperative days 7 – 9 and the preoperative computed tomography density classification (isodense or hyperdense, or separated or laminar types). Cerebral atrophy played a key role in brain re-expansion. The CSDH prognostic grading system ranged from 0 to 3. An increased score was associated with a more accurate progressive increase in the RrR rate. Our grading system demonstrated the best predictive performance compared with other systems (area under the curve = 0.856).Conclusions Our prognostic grading system could quickly and effectively screen high-risk RrR patients with unilateral CSDH. However, increased attention should be paid to brain re-expansion rate after surgery in patients with CSDH.

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“…Eleven studies investigated the role of DX. [13][14][15][16][17][18][19][20][21][22][23] We retrieved 1067 cases in which DX was administered: in 810 cases as adjuvant treatment, whereas 257 patients received DX as primary treatment. The cohorts that received DX alone showed the most unfavorable outcomes: surgical procedures for hematoma evacuation were required, ranging from 22% to 83% of patients in different series.…”

Section: Medical Treatments: Txa and DXmentioning

confidence: 99%

“…The cohorts that received DX alone showed the most unfavorable outcomes: surgical procedures for hematoma evacuation were required, ranging from 22% to 83% of patients in different series. [14][15][16][17][18][19][20][21][22] On the other hand, adjuvant corticosteroids after surgery resulted in a recurrence rate of 11.6%, ranging from 0% to 40% among the different studies. 16,18,19,21,23 Endovascular Treatment: MMAE MMAE is a relatively new technique; it was first reported in the early 2000s.…”

Section: Medical Treatments: Txa and DXmentioning

confidence: 99%

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

Scerrati

Visani

Ricciardi³

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODSThe authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were “chronic subdural hematoma,” “conservative treatment/management,” “pharmacological treatment,” “non-surgical,” “tranexamic acid,” “dexamethasone,” “corticosteroid,” “glucocorticoid,” “middle meningeal artery,” “endovascular treatment,” and “embolization.”RESULTSThe authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONSThe results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.

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Dexamethasone Therapy in Symptomatic Chronic Subdural Hematoma (DECSA–R): A Retrospective Evaluation of Initial Corticosteroid Therapy versus Primary Surgery

Cited by 40 publications

References 23 publications

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis

Development of the Chronic Subdural Hematoma Grading System to Predict Postoperative Recurrence

To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

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